Term Newborn Infants Research Articles

The role of nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in diagnosis of late onset neonatal sepsis.

Neonatal sepsis is a major cause of morbidity and mortality among neonates. Nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is a core element for innate immune protection. The study aims to estimate the expression of NLRP3 inflammasome in full term newborn infants who suffer from late onset sepsis, in order to assess its diagnostic value. This case-control study was conducted in NICU. 40 newborns with late onset sepsis, and 40 control neonates were included. The analysis of NLRP3 inflammasome was done by ELISA. There was a significant elevation of NLRP3 inflammasome in the serum of neonates with late onset sepsis group than the control group, P values were < 0.001, and the best cut off value of NLRP3 to detect late onset septic was > 3 ng/ml with sensitivity of 92.5% and specificity of 97.5%. Receiver operating characteristic curve showed that the best cut off point of NLRP3 to predict mortality in cases group was > 7.29 with sensitivity of 75.0%, specificity of 91.67%, PPV of 50.0%, NPV of 97.1% and total accuracy of 0.84%. n-SOFA scoring system increased significantly among LOS group and there was positive correlation with NLRP 3 inflammasome, P < 0.012. NLRP3 inflammasome can be used for the diagnosis of late onset neonatal sepsis. The increase of its values was not affected by gender, birth weight, gestational age and postnatal age. It was the novel sepsis markers that were not fully studied in neonatal population. The prognostic values may need further studies.

Bedside Cerebral Blood Flow Quantification in Neonates.

Measurement of blood flow to the brain in neonates would be a very valuable addition to the medical diagnostic armamentarium. Such conditions such as assessment of closure of a patent ductus arteriosus (PDA) would greatly benefit from such an evaluation. However, measurement of cerebral blood flow in a clinical setting has proven very difficult and, as such, is rarely employed. Present techniques are often cumbersome, difficult to perform and potentially dangerous for very low birth weight (VLBW) infants. We have been developing an ultrasound blood volume flow technique that could be routinely used to assess blood flow to the brain in neonates. By scanning through the anterior fontanelles of 10 normal, full-term newborn infants, we were able to estimate total brain blood flows that closely match those published in the literature using much more invasive and technically demanding methods. Our method is safe, easy to do, does not require contrast agents and can be performed in the baby's incubator. The method has the potential for monitoring and assessing blood flows to the brain and could be used to routinely assess cerebral blood flow in many different clinical conditions.

Evaluation of Insulin Resistance among Full Term and Preterm Newborn Infants using Homeostasis Model Assessment - Insulin Resistance

Evaluation of Insulin Resistance among Full Term and Preterm Newborn Infants using Homeostasis Model Assessment - Insulin Resistance

Diagnostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Detecting Acute Kidney Injury in Asphyxiated Term Neonates

Background: Neonates with Perinatal Asphyxia (PNA) are at higher risk for developing Acute Kidney Injury (AKI). Conventionally, Serum Creatinine (SCr) is used to diagnose AKI but lacks specificity during the first few days of life. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has emerged as a novel biomarker of AKI in such situations, while its value in our setting is yet to be validated. The study aimed to evaluate the role of urinary NGAL (uNGAL) level as a predictive biomarker of AKI in term newborn infants with PNA.&#x0D; Materials and methods: This prospective observational study included 55 full-term neonates with PNA from the Special Care Neonatal Unit of Chittagong Medical College Hospital.The uNGAL was measured by an enzyme-linked immunosorbent assay. Urinary samples were obtained for uNGAL on postnatal day 1(after 6 hours), and on day 3, blood samples for sCr were obtained on postnatal day1, 3 and 6.&#x0D; Results: Among 55 neonates with PNA, 20 (36.4%) had AKI. The mean ±SD uNGAL level was 97.77±17.13 ng/ml in neonates with AKI compared to 25.76±2.19 ng/ml in those without AKI in the first postnatal day. An uNGAL cutoff value of 28.86 ng/ml had 90.0% sensitivity and 82.9% specificity in predicting AKI the same day. The mean value of uNGAL was observed at a lower level, 54.53±14.72 ng/ml vs 15.17±2.18 ng/ml in AKI and no AKI neonates on third postnatal days. The cutoff value for detecting AKI was seen to be 26.43 ng/ml with high validity on this day. Significant differences in sCr were observed between AKI and no AKI measuring on days one and three, whereas the difference was not significant on day six.&#x0D; Conclusion: The study showed that uNGAL might be a valuable biomarker for predicting AKI among neonates with PNA.&#x0D; JCMCTA 2022 ; 33 (1) : 173-177

DNA methylation profiles in the blood of newborn term infants born to mothers with obesity.

Maternal obesity is an important risk factor for childhood obesity and influences the prevalence of metabolic diseases in offspring. As childhood obesity is influenced by postnatal factors, it is critical to determine whether children born to women with obesity during pregnancy show alterations that are detectable at birth. Epigenetic mechanisms such as DNA methylation modifications have been proposed to mediate prenatal programming. We investigated DNA methylation signatures in male and female infants from mothers with a normal Body Mass Index (BMI 18.5–24.9 kg/m2) compared to mothers with obesity (BMI≥30 kg/m2). BMI was measured during the first prenatal visit from women recruited into the Ontario Birth Study (OBS) at Mount Sinai Hospital in Toronto, ON, Canada. DNA was extracted from neonatal dried blood spots collected from heel pricks obtained 24 hours after birth at term (total n = 40) from women with a normal BMI and women with obesity matched for parity, age, and neonatal sex. Reduced representation bisulfite sequencing was used to identify genomic loci associated with differentially methylated regions (DMRs) in CpG-dense regions most likely to influence gene regulation. DMRs were predominantly localized to intergenic regions and gene bodies, with only 9% of DMRs localized to promoter regions. Genes associated with DMRs were compared to those from a large publicly available cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC; total n = 859). Hypergeometric tests revealed a significant overlap in genes associated with DMRs in the OBS and ALSPAC cohorts. PTPRN2, a gene involved in insulin secretion, and MAD1L1, which plays a role in the cell cycle and tumor suppression, contained DMRs in males and females in both cohorts. In males, KEGG pathway analysis revealed significant overrepresentation of genes involved in endocytosis and pathways in cancer, including IGF1R, which was previously shown to respond to diet-induced metabolic stress in animal models and in lymphocytes in the context of childhood obesity. These preliminary findings are consistent with Developmental Origins of Health and Disease paradigm, which posits that adverse prenatal exposures set developmental health trajectories.

Trends in the use of non-invasive respiratory support for term infants in tertiary neonatal units in Australia and New Zealand

ObjectiveTo determine whether the use of non-invasive respiratory support, such as continuous positive airway pressure and nasal high flow, to treat term infants in Australian and New Zealand tertiary neonatal...

Erythropoietin as a Neuroprotective Drug for Newborn Infants: Ten Years after the First Use.

Protective strategies against perinatal brain injury represent a major challenge for modern neonatology. Erythropoietin (Epo) enhances endogenous mechanisms of repair and angiogenesis. In order to analyse the newest evidence on the role of Epo in prematurity, hypoxic ischemic encephalopathy (HIE) and perinatal stroke, a critical review using 2020 PRISMA statement guidelines was conducted. This review uncovered 26 clinical trials examining the use of Epo for prematurity and brain injury-related outcomes. The effects of Epo on prematurity were analysed in 16 clinical trials. Erythropoietin was provided until 32–35 weeks of corrected postnatal age with a dosage between 500–3000 UI/kg/dose. Eight trials reported the Epo effects on HIE term newborn infants: Erythropoietin was administered in the first weeks of life, at different multiple doses between 250–2500 UI/kg/dose, as either an adjuvant therapy with hypothermia or a substitute for hypothermia. Two trials investigated Epo effects in perinatal stroke. Erythropoietin was administered at a dose of 1000 IU/kg for three days. No beneficial effect in improving morbidity was observed after Epo administration in perinatal stroke. A positive effect on neurodevelopmental outcome seems to occur when Epo is used as an adjuvant therapy with hypothermia in the HIE newborns. Administration of Epo in preterm infants still presents inconsistencies with regard to neurodevelopmental outcome. Clinical trials show significant differences mainly in target population and intervention scheme. The identification of specific markers and their temporal expression at different time of recovery after hypoxia-ischemia in neonates might be implemented to optimize the therapeutic scheme after hypoxic-ischemic injury in the developing brain. Additional studies on tailored regimes, accounting for the risk stratification of brain damage in newborns, are required.

Foot-to-Foot Contact Among Initial Goal-Directed Movements Supports the Prognostic Value of Fidgety Movements in HIE-Cooled Infants.

Background: Few studies conducted to date have observed general movements in infants affected by hypoxic–ischemic encephalopathy (HIE) who underwent therapeutic hypothermia. We investigated whether foot-to-foot contact (FF) could support the predictive value of fidgety movements (FMs) in infants affected by HIE and treated with brain cooling.Methods: Spontaneous motility was video recorded for 3–5 min at 12 weeks post-term age in 58 full-term newborn infants affected by perinatal asphyxia who were cooled due to moderate to severe HIE. FF and FMs were blindly scored by three independent observers. At 24 months, each patient underwent a neurological examination by Amiel-Tison and Grenier.Results: At 24 months, 47 infants had developed typically at neurological examination, eight had developed mild motor impairment, and three developed cerebral palsy (CP). At 12 weeks, 34 (58.6%) infants had shown normal FMs, four of whom developed mild motor impairment. Twenty-four infants (41.4%) exhibited abnormal or no FMs, four of whom developed mild motor impairment and three developed CP. FF was present in 20 infants (34.5%), two of whom developed mild motor impairment. FF was absent in 38 infants (65.5%), six of whom developed mild motor impairment and three developed CP. Both FMs and FF, considered separately, were 100% sensitive for predicting CP at 24 months, but only 61 and 36%, respectively, were specific. Summing the two patterns together, the specificity increases to 73%, considering only CP as an abnormal outcome, and increases to 74% when considering CP plus mild motor impairment. Unexpectedly, fidgety movements were absent in 24 infants with typical motor outcomes, 17 of whom showed a typical motor outcome.Conclusions: FF is already part of motor repertoire at 12 weeks and allows a comparison of spontaneous non-voluntary movements (FMs) to pre-voluntary movements (FF). FF supports FMs for both sensitivity and specificity. A second video recording at 16–18 weeks, when pedipulation is present in healthy infants, is suggested: it may better define the presence or absence of goal-directed motility.

Ultrasonographic assessment of testicular volume in Japanese newborn infants.

Purpose : It is essential to determine normative data of testicular size and penile length in newborn infants in order to assess the development during the fetal period. In this study, we evaluated testicular volumes using ultrasonography and also measured penile lengths in Japanese newborn infants. We also examined the associations of the development of these organs with factors including placental weight and anthropometric data. Methods : One hundred and fifteen full-term male newborn infants were recruited for this study. Testicular size was measured by ultrasonography. Results : Mean testicular volumes were 187.4 mm3 in the right testis and 185.4 mm3 in the left testis, and there was no significant difference between the right and left testicular volumes. Right and left testicular volumes showed positive and significant correlations with body lengths and weights. Testicular volumes in the right and left sides were not significantly associated with penile lengths. In 4 groups according to gestational weeks, testicular volume increased significantly with advance of gestational weeks in the left testis. Conclusion : We determined testicular volumes using ultrasonography in Japanese newborn infants. We believe that the results for newborn infants provide important information for assessment of the development of fetal testicular volume. J. Med. Invest. 69 : 256-260, August, 2022.

Peritoneal dialysis for term neonates in a neonatal intensive care unit.

This study aimed to evaluate the indications, complications, and outcomes of peritoneal dialysis (PD) in term neonates from a state hospital. The demographic, clinical, and laboratory data of 67 newborn term infants who underwent PD within the first 4 weeks of life between June 2014 and June 2019 were retrospectively analyzed. Twenty-five patients (37.3%) were male, 42 (63.7%) were female. The mean gestational age was 38.3 ± 0.8 (range: 37-40) weeks and mean birthweight 3,100 ± 504.9 g (range: 1,800-5,000 g). The mean age of patients at the start of dialysis was 7.97 ± 8.34 days (range:1-44 days) and the mean duration for dialysis was 3 ± 5.42 days (range 1-40 days). The majority of patients who underwent PD had inborn error of metabolism (59.7%). The most common complication was dialysate leakage. Thirty-three neonates (49.2%) died during PD process because of underlying disease, 17 patients (25.4%) were referred to other centers, and 17 patients (25.4%) were discharged. There were seven acute kidney injury patients associated with hypernatremic dehydration. There were statistically significant differences between non-survivors and survivors in terms of dialysis duration, birthweight, weight at admission, requirements for mechanical ventilation, and inotrop agent, and also the renal angina index. In our region, hypernatremic dehydration is still a one of the major cause for acute kidney injury (AKI) in newborns. In state hospitals, pediatric specialists must be present in neonatal intensive care units in order not to refer unstable patients to other centers and to provide high-quality patient care.

Instructional guides for filming infant movements at home are effective for the General Movements Assessment.

To determine the effectiveness of two instructional guides to obtain video recordings for the General Movements Assessment (GMA). A cross-sectional study of a community sample of family participants with low-risk term newborn infants recruited via social media and randomly allocated to receive one of two instructional guides (detailed or quick versions) to film their infant's movements at home. Participants returned videos via a secure Research Electronic Database Capture link and videos were scored for quality across 10 criteria, along with scoring the GMA. Participants were surveyed about their perceptions of the instructional guides and electronic file transmission. Seventy-six parents of infants were enrolled and randomly allocated to receive detailed (n=38) and quick (n=38) instructions to film their infant for a GMA. Videos were returned by 87% (95% confidence interval (CI) 72%, 96%) of detailed instruction users and 84% (95% CI 69%, 94%) of quick instruction users. The GMA could be conducted on all returned videos. The mean score for video quality was 9.9/10 (standard deviation 0.4, 95% CI 9.7, 10.0) for detailed instructions and 9.7 (standard deviation 0.6, 95% CI 9.4, 9.9) for quick instructions. Overall, participants felt that either instructional guide was easy to use. Fifteen (20%) participants had difficulties with video file transmission, requiring additional support. Parents can successfully use one of two different instructional guides for filming their infant's movements for GMA; however, support should be provided for safe and easy file transmission.

Study of Neuropeptide Substance P as A Marker of Pain in Newborn Infant

BACKGROUND: Prolonged and repeated untreated pain in newborn infant may produce a relatively permanent adverse long-term sequela. AIM: The aim of this study was to evaluate the potential role for neuropeptides substance P (SP) as neurochemical pain marker in newborn infants in order to decrease unnecessary use of analgesics and protect the developing brain. METHODS: This case-control study was conducted on 60 newborn infants. They were assigned to four groups, control preterm, sick preterm, control full term, and sick full term. All neonates were subjected to estimation of pain through neonatal infants pain score (NIPS) as well as Neuropeptide SP on the 1st and 5th day of life. The NIPS addresses five behavioral parameters (facial expression, crying, arm movement, leg movement, and state arousal) and one physiological parameter (breathing pattern). Results were further evaluated according to nature of the procedures; invasive and non-invasive procedures. RESULTS: There was a significant increase in the severity of pain score among the sick preterm and full-term infants after invasive procedures. There was a significant increase in SP in the sick preterm group than the control preterm on the 1st and 5th day of life; p were =0.003 and = 0.037, while full-term infants showed significant increase on the 5th day; p = 0.005. Furthermore, there was no significant difference in SP values between the preterm and full-term infants on the 1st and 5th day of life. SP increased significantly after invasive procedures than noninvasive procedures in the sick full-term and sick preterm infants weather in the 1st or 5th day of life. There was a significant correlation between the pain score NIPS and SP level on the 1st day of life. CONCLUSION: SP can be used as pain marker in sick preterm and full-term newborn infants. It showed increase with invasive procedures, acute and chronic pain.

Role of Serum Apelin in the Diagnosis of Early-Onset Neonatal Sepsis.

Objective:Apelin is a proinflammatory adipocyte-derived factor. The aim of this study was to evaluate the role and significance of serum apelin as a new sepsis marker in the identification of full-term and preterm new-born infants with early-onset sepsis.Material and Methods:This was a case-control study. We included 80 neonates. The cases were divided into 2 groups; neonates with early-onset sepsis and control group with neonates non-sepsis. Apelin was quantified by enzyme-linked immunosorbent assay.Results:There was a significant elevation in the mean values of serum apelin in the early-onset sepsis group (1214.7 ± 273.06 pg/mmol) than in the non-septic neonates 116.27 ± 21.96 pg/mmol (P < .0001). Apelin values were correlated to clinical sepsis and hematological scores as well as C-reactive protein. Serum apelin concentration was significantly higher among culture-positive cases than the culture-negative cases (mean ± SD was 1239.52 ± 268.47 and 929.42 ± 136.97 pg/mmol, respectively, P < .0001). Moreover, the apelin level was higher in non-survivor neonates than in the survivors in the early-onset sepsis group. No significant difference was found between preterm and full-term new-born infants with regard to the apelin values. The best cut-off estimate of apelin to diagnose early sepsis was >178.33 pg/mmol.Conclusion:Apelin may be useful in the diagnosis and prognostic prediction of neonates with early-onset sepsis.

Retinal abnormalities in universal eye screening of healthy, full-term newborn infants in Jakarta. The incidence and its risk factors: a pilot study

AimTo screen for ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings.MethodsA total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 h after birth using the RetCam shuttle (Natus Medical Incorporated, USA). Retinal findings were documented and analyzed according to obstetric and neonatal risk factors.ResultsOf the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common finding (88%) in which 2.67% involved the macula, followed by chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18–0.41, p < 0.001) was a protective factor against RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24–2.72, p = 0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19–0.44, p < 0.001), while other risk factors were not.ConclusionsOur study showed that universal eye screening in healthy neonates is beneficial in the early diagnosis, monitoring and treatment of ocular abnormalities such as retinal hemorrhage, chorioretinitis and retinoblastoma. Retinal hemorrhage is the most common ocular abnormality and is associated with the delivery method and the duration of labor. Universal eye screening is visual-saving and life-saving for neonates with chorioretinitis, retinoblastoma as well as other abnormalities and should be mandatory in newborn screening.

Lesão no couro cabeludo de um recém-nascido

A full-term newborn infant born by vaginal delivery presented with an oval skin defect on the parietal scalp measuring 0.5x0.5 cm. The scalp lesion was conservatively managed, with complete epithelization after several weeks. This skin lesion is consistent with the typical appearance of aplasia cutis congenita (ACC) on the scalp.ACC is a rare malformation (present in 1 to 3 in 10,000 live births) characterized by localized absence of certain skin layers, mostly on the scalp, but potentially in any part of the body. ACC etiology remains unclear. Diagnosis is mainly clinical and treatment depends on the presence of complications and the child’s condition. A conservative approach is traditionally used for small defects that heal uneventfully with gradual epithelization, as in the present case.

A review of the characteristics, mechanisms and clinical significance of habituation in foetuses and newborn infants.

Habituation has been a topic of interest since the early 20th century. We summarise the characteristics of habituation, the proposed habituation mechanisms, the associated cortical responses and the link between habituation and cognitive development. Behavioural and neuroimaging studies have highlighted the early sensory abilities of foetuses and newborn infants, with preterm newborn infants exhibiting decreased habituation and dishabituation capabilities that increase their environmental vulnerability. Habituation provides a foundation for the learning and cognition on which higher functions are constructed. It has been suggested that it is efficient for predicting cognitive developmental outcomes in term and preterm newborn infants.

Экспресс-метод для определения вероятности развития врожденной пневмонии у доношенных новорожденных

По данным Всемирной организации здравоохранения, в 2017 году во всем мире от пневмонии умерло 15 % детей в возрасте младше пяти лет. Цель исследования: разработка математической модели для определения вероятности развития врожденной пневмонии у доношенных новорожденных экспресс-методом. Проведено комплексное обследование 116 доношенных новорожденных, находившихся в педиатрическом отделении для новорожденных детей и родильном физиологическом отделении Государственного учреждения «Республиканский научно-практический центр «Мать и дитя» в период с 2017 по 2019 год. Произведен сравнительный анализ 174 данных анамнеза жизни, исходов предыдущих беременностей, осложнений настоящей беременности у матерей, клинических и рутинных лабораторных методов исследования у новорожденных на 1–2-е сутки жизни. В последующем определены наиболее значимые факторы, ассоциированные с развитием врожденной пневмонии у доношенных новорожденных. На основании бинарной логистической регрессии и ROC-анализа проведен математический анализ 387,4 млн связей переменных. В результате проведенного обследования установлены наиболее значимые факторы, ассоциированные с развитием врожденной пневмонии у доношенных новорожденных: из акушерско-гинекологического и соматического анамнеза жизни матери — самопроизвольный выкидыш; из осложнений беременности — хроническая внутриматочная гипоксия плода и хроническая фетоплацентарная недостаточность; по результатам клинических проявлений в первые сутки жизни — наличие дыхательной недостаточности. На основании полученных данных разработана модель с чувствительностью, равной 90,6 %, специфичностью — 92,1 % и площадью под ROC-кривой — AUC = 0,93 ± 0,054; р &lt; 0,001 (95% доверительный интервал 0,88–0,98). С помощью прогностической модели рассчитаны пороговые значения: для самопроизвольного ± выкидыша — 0,836; хронической внутриматочной гипоксии плода — 0,537; хронической фетоплацентарной недостаточности — 0,533; наличия дыхательной недостаточности — 0,939, что при пороговых значениях ≥ 0,53 ROC-кривой позволяет выделить группу высокого риска по развитию врожденной пневмонии среди доношенных новорожденных. С действующей математической моделью для определения вероятности развития врожденной пневмонии у доношенных новорожденных экспресс-методом можно ознакомиться на сайте http://pneu.bsmu.by или https://www.bsmu.by (внизу страницы меню «Врач/провизор: диагностика врожденной пневмонии»).

Non-invasive monitoring of saliva can be used to identify oxidative stress biomarkers in preterm and term newborn infants.

The aim of this study was to appraise the feasibility and reproducibility of applying a validated analytical method to determine salivary oxidative stress biomarkers in newborn infants. Prospective observational single-centre study was carried out in level III neonatal intensive care unit. Eligible patients were preterm infants and healthy full-term newborn infants. Salivary samples were analysed in the chromatographic system. A total of 23 premature newborn infants and 13 full-term newborns were included. We analysed salivary levels of oxidative stress biomarkers for 5-F2t isoprostane, 15-E2t isoprostane, prostaglandin E2 and prostaglandin F2α. The multivariate predictive model showed a positive association between female and 5-F2t isoprostonae, and between female sex and prostglandin F2α. In addition, we found a positive association between gestational age and levels of prostaglandin E2 . Furthermore, in the premature group, we found a positive association between the inspired fraction of oxygen and levels of prostaglandin G2 . We identified and determined lipid peroxidation biomarkers in term and preterm newborn infants' saliva using specific and validated mass spectrometry technology.

Neuroendoscopic surgery in neonates \u2014 indication and results over a 10-year practice

PurposeNeuroendoscopic procedures for treatment of term and preterm newborn infants, such as endoscopic lavage for posthemorrhagic hydrocephalus, are gaining popularity despite sparse data. This single-institution report compiles all neuroendoscopic surgical procedures performed in neonates during a 10-year period.MethodsCharts and electronic records were reviewed of all consecutive newborns who underwent a neuroendoscopic procedure before reaching a postmenstrual age of 44 weeks between 09/2010 and 09/2020. Available documentation was reviewed regarding the performed neuroendoscopic procedure, course of disease, complications, and all re-operations throughout the first year of life.ResultsDuring the 10-year study period, 116 infants (median gestational age at birth: 29 1/7 weeks) underwent a total of 153 neuroendoscopic procedures (median postmenstrual age at surgery: 35 0/7 weeks). The most common indication at the time of the neuroendoscopic procedures (n = 153) was intraventricular hemorrhage (IVH, n = 119), intraventricular infection (n = 15), congenital malformation (n = 8), isolated 4th ventricle (n = 7), multiloculated hydrocephalus (n = 3), and tumor (n = 1). Thirty-eight of 116 children (32.8%) underwent 43 operative revisions after 153 neuroendoscopic procedure (28.1%). Observed complications requiring surgical revision were secondary infection (n = 11), CSF fistula (n = 9), shunt dysfunction (n = 8), failure of ETV (n = 6), among others. 72 children (62%) of 116 children required permanent CSF diversion via a shunt. The respective shunt rates per diagnosis were 47 of 80 (58.8%) for previously untreated IVH, 11 of 13 (84.6%) for intraventricular infection. Shunt survival rate for the first year of life was 74% for the whole cohort.ConclusionThe experience with this large cohort of neonates demonstrates the feasibility of neuroendoscopic technique for the treatment of posthemorrhagic or postinfectious hydrocephalus. Rate and type of complications after neuroendoscopic procedures were within the expected range. Assessing the potential long-term benefits of neuroendoscopic techniques has to await results of ongoing studies.

Protein Profile and Simulated Digestive Behavior of Breast Milk from Overweight and Normal Weight Mothers.

Human milk proteins have shown to vary in concentration and distribution through lactation. However, while some regulatory components, such as hormones, have shown associations with regard to the mothers’ body mass index, there is limited information on the possible influence of this condition on the whole protein distribution. The objective of this study was to evaluate the protein profile of human milk from normal weight and overweight or obese mothers to identify differences in protein expression in colostrum, transitional and mature milk. The mass spectrometry analysis showed the ability to class with a high degree of confidence the lactation state and the milk profile according to the mother’s condition. Individual milk samples were subjected to a digestion in vitro model that takes into account the specificities of the gastrointestinal conditions of full-term newborn infants. The digestion products were compared with available data from the digestive contents in newborns. The behavior of the most abundant proteins and the overall peptide generation and survival, showed good correspondence with in vivo data.